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November 16, 2020

Moderna Announces Promising Vaccine Results. Following on the heels of last week's news about the Pfizer COVID-19 vaccine, Moderna today released preliminary results of their trials, which show similar promise. Moderna described a 94.5% efficacy from the first 95 trial participants who developed COVID-19, out of more than 30,000 total. They expect to apply for an Emergency Use Authorization "in the coming weeks" when the final data are available. Moderna projects that they can manufacture 20 million doses of their vaccine by the end of 2020 and 500 million to 1 billion by the end of 2021. Like the Pfizer vaccine, Moderna's requires two doses, but unlike Pfizer, the Moderna vaccine reportedly can be stored in a typical freezer and can be kept refrigerated for 30 days. This difference opens up a lot more possibilities for long-term services and supports providers that we will explore with the state.

SNF QIP Exclusion List. A common question in the two weeks since the Department of Health and Human Services (HHS) paid the first installments under the SNF Quality Incentive Program (QIP) is why some centers did not receive payments. AHCA replicated the HHS methodology, including the criteria relating to National Healthcare Safety Network (NHSN) reporting, and produced a table identifying why they believe the centers listed in the table were excluded. Please use this link to download an Excel workbook for Ohio that includes two tabs. The "Facility Data" tab shows the excluded facilities and has columns with the various reasons for exclusion. The "Cover Sheet" tab explains these reasons and provides links for further investigation. After reviewing this information, if you feel your center was excluded erroneously, please email Pete Van Runkle including your Centers for Medicare and Medicaid Services (CMS) Certification Number (CCN). We will compile and forward these buildings to AHCA, which in turn will take them to HHS.

AL Mandatory Reporting Reopens. Following completion of the latest two-week testing cycle, the Department of Aging (ODA) reopened test result reporting for assisted living communities, adult day care centers, and senior centers. Reporting is required whether the center is using state-supported testing or not. The reporting period is today through Wednesday and covers testing done between October 26 and November 8. Please use this reporting tool to comply. Per ODA, "[f]acilities should ensure they have readily available details about the tests performed and test results in order to complete the reporting tool. The reporting tool must be completed in one session and should be submitted by each facility once during a reporting period. Facilities should submit only one report during this reporting period. All questions in the reporting tool must be fully and accurately answered." Any inquiries about reporting should go to

SNF Testing Update. Director of Aging Ursel McElroy informed us that the next SNF testing schedule, which will start next Monday, should be out early this week. She said SNFs that fully opted into state support will receive enough supplies to cover twice-a-week testing plus outbreak testing of residents even if they are not located in a CMS red county. She added that the following numbers of SNFs selected each option on the opt-in/opt-out survey:

  • Fully opted in                                        481
  • Antigen only                                           74
  • Polymerase chain reaction (PCR) only      115
  • Opt out                                                 158
  • No response                                          130
The Director expressed concern about the non-respondents. She said her staff is attempting to contact these facilities and asked for the associations' help. She also asked that SNFs utilize their point-of-care testing machines as a back-up in the event they do not have enough supplies from state support or otherwise need to augment testing.

Aetna Waives SNF Prior Authorization for All Product Lines. OHCA received notification today that Aetna and Aetna Better Health of Ohio will waive prior authorization requirements for all SNF admissions through December 14, 2020. The SNF must notify Aetna of admission within 48 hours. Providers may submit their request either by fax or phone. The post-acute care facility also must send medical records for concurrent review within three days of the initial admission. Medical records can be sent to Aetna Better Health by fax to 855-734-9393 or to Aetna by fax at 833-596-0339. Please include the patient’s name and member identification number on the cover sheet.

• Aetna requires:

  • Hospital history and last two to three days' progress notes.
  • Any information that demonstrates a need for post-acute care.
  • Anticipated discharge plan with estimated length of stay.

• This change does not apply to transfer between facilities or level of care changes within a SNF.

ODM Suspends Managed Care Prior Authorization Requirements for SNF Admission. After individual health plans issued notices regarding prior authorization waivers, ODM released a memo mandating that Medicaid plans immediately lift prior authorization requirements for SNF admissions. An important distinction from the plan-specific notices is ODM also prohibits limited authorizations, i.e., three-day authorizations upon notification a SNF admission. The memo applies to Medicaid managed care organizations, which include Paramount Medicaid products, and MyCare Ohio plans, which include MyCare Medicaid and Managed Medicaid for Aetna Better Health of Ohio, Buckeye Health Plan, CareSource Ohio, United Healthcare Community Plan, and Molina Healthcare. ODM added in the memo, "[i]f you become aware of particular situations that aren’t resolved expeditiously through normal channels and relationships please gather the relevant information, including name/phone no. for the contact person at both facilities/organizations and send it to" Please note that this directive does not apply to other product lines such as Medicare Advantage, commercial, and Marketplace plans.

Revised Order on Mass Gatherings. As presaged last week in Governor Mike DeWine's address to Ohio, Interim Health Director Lance Himes issued a revised order on mass gatherings. The order prohibits gatherings of more than 10 people, but there are a variety of exceptions such as gatherings within a residence or on the property where it is located. The order, however, zeroes in on weddings, funerals, and similar events held in banquet halls with a series of requirements that attempt to maintain distancing. One of the exceptions is for gatherings that are permitted by other orders, which would include orders specific to long-term services and supports settings.

AHCA/NCAL Survey for Providers – Financial Situation Due to COVID. AHCA/NCAL is asking providers (SNF, AL, ICF/IID) to complete a survey in regard to COVID-19’s impact on their facility/company. Providers will be asked about several topics, including workforce, personal protective equipment, testing, and finances. Providers may download a copy of the questionnaire, if they wish to gather the necessary information before filling it out online.

We are asking members to complete the survey by end of the day Friday, November 20, and it should take 15-20 minutes complete. Please use this link to the online survey. We are hoping to be able to provide a state breakdown of the results once the survey closes, which will then be made available to State Affiliates. Thank you for your support!

A New Infection Control Program Designed for Skilled Nursing and Assisted Living Staff. The AHCA/NCAL Infection Control Certificate Program features two main areas.

Five eLearning modules that provide basic knowledge in the following areas:

  1. Infection Prevention and Control for All Staff
  2. Coronavirus Disease (COVID-19)
  3. Personal Protective Equipment (PPE)
  4. Hand Hygiene
  5. COVID-19: PPE Guidance for Use

Five eCompetenciesTM with evidence-based digital checklists that allow evaluators to confirm step-by-step knowledge and competency for:

  1. Personal Protective Equipment (PPE): Applying and Removing
  2. Handwashing
  3. Surgical Face Mask: Application and Removal
  4. N95 Respirator Application and User Seal Check
  5. Cleaning and Disinfecting Environmental Surfaces

Have Questions? Call (866) 323-4169 or e-mail